EMD & China - A History

HIV/AIDS Related Collaborations between Yale School of Public Health and the Chinese National Center for AIDS Prevention and Control

Yale University and its faculty have collaborated for over 150 years with institutions and individuals in China. For example, Yale educated the first Chinese student to graduate from an American college or university, was the first American college to teach Chinese and holds one of the three largest Chinese language library collections in North America. Yale graduates also helped establish the Hunan Medical University in Hunan Province in 1914; close collaboration continues today between that University and Yale University.

In 1989, the Union School of Public Health (USPH) was established to provide a contemporary, post-graduate, public health education in China. It was then located within the Chinese Academy of Preventive Medicine (CAPM) and comprised of faculty from CAPM; Peking Union Medical College, a historically elite medical college associated with the Chinese Academy of Medical Sciences; and Beijing Medical University. The USPH is unique among the schools of public health in China in that its entering students must have professional experience in public health and are required to return to their previous employment after graduation. Accordingly, USPH offers more practical training in public health than any other Chinese public health school. USPH matriculates students with a Master of Public Health (MPH) degree. The School’s first Dean, Dr. Chen Chunming, was the former President of the CAPM and was a senior advisor to the Ministry of Health (MOH) on HIV/AIDS related issues.

Aware of this tradition, the Rockefeller Foundation in 1997 requested Yale’s School of Public Health, to assist the USPH in the development of materials for a comparative law course. Upon successful completion of this course, USPH requested assistance from YSPH in strengthening its curriculum in other areas, including health economics, smoking control and environmental health and the social and behavioral sciences. In 1998, the Proctor and Gamble Company provided a three-year grant of $400,000 to support this collaboration. The main activity areas included in this collaboration were: faculty exchanges to strengthen the USPH curriculum in the above-mentioned subjects; curriculum dissemination to other public health schools in China; collaborative research on major health concerns in China within the areas of health economics, social and behavioral sciences, air pollution and nutrition; and EPH MPH student internships at USPH. This project was jointly managed by Dr. Chen Chunming and Dr. Michael Merson, former Dean of Yale School of Public Health.

USPH faculty were asked by the MOH to design and field test a series of indicators for use by provincial staff in monitoring the progress of the World Bank Project. These indicators were related to HIV prevalence, high-risk behavior, policy change and access to health services.

In 1999, Yale was awarded a one-year administrative supplement from the Fogarty International Center at NIH to begin a training and research program on HIV/AIDS prevention in China. Under this supplement to an AIDS International Training and Research Program, short-term training was provided for three technical experts from central and provincial levels who are actively involved in the World Bank Project. Two experts (Drs. Zunyou Wu and Jingkun Zhang) were from the central level and Dr. Zhendong Liu was from the Xinjiang Province.

While at Yale, Dr. Zunyou Wu assisted in designing the training program which resulted in the AITRP Supplement to China (2000-2003). In addition, Dr. Wu collaborated with Drs. Michael Merson and Kaveh Khoshnood in developing the proposal which resulted in the World AIDS Foundation pilot study.

A Pilot Study of Voluntary HIV Counseling and Testing of Pregnant Women in Urumqi, China

Funded by the World AIDS Foundation in August 2000, this study was a collaboration by Yale School of Public Health with the Chinese National Center for AIDS Prevention and Control, the Chinese Academy of Preventative Medicine and the Xinjiang Center for AIDS Prevention and Control, Xinjiang Anti-Epidemic Center. This 24 month pilot study evaluated an intervention of mandatory HIV counseling and voluntary testing of pregnant women in Urumqui, the capital city of Xinjiang in China. Prior to the implementation of the intervention, health care workers involved in the care of pregnant women received comprehensive training in HIV counseling and testing. Two strategies were compared: one involving counseling pregnant women only (standard clinics) and the other involving pregnant women and their male partners (experimental clinics). A total of twelve prenatal clinics were selected and randomly assigned to either standard or experimental clinics. The results of this pilot study were used to guide Chinese health officials in replicating similar interventions throughout China and their goal of preventing further transmission of HIV among pregnant women.

In October 2000, our Fogarty International Center AIDS International Training and Research Program (AITRP) was awarded a three-year supplement to provide short-term training at Yale University for Chinese technical experts in the design and evaluation of behavioral interventions for prevention of HIV infection. Dr. Kaveh Khoshnood was the project director and mentor for trainees at Yale. During the supplement period, 14 trainees who work at the central (federal) or provincial level and provide technical leadership within the World Bank Health IX Project (1999 – 2004). Most of our trainees are currently serving in public health management positions.

This Fogarty International Center International Clinical Operational, Research and training award (ICOHRTA AIDS/TB (IAPH1) was awarded in 2004. The training program in China was carried out with the China CDC and supported through a subcontract with UCLA. Focused on policy, health services and nursing research, this program was designed to 1) provide research training to senior staff at the China CDC and its affiliated institutions, who were then able to provide leadership in multidisciplinary HIV research, direct training efforts, provide further training/mentoring, and influence policy-making in the disciplines of biostatistics, behavioral sciences, anthropology, nursing, AIDS treatment, health services and policy; 2) develop a core group of young scientists who will assume roles as HIV/AIDS researchers and teachers, through joint master's and doctoral programs with UCLA and Yale; 3) provide research training to key research staff at project sites and graduates of schools of public health in Yunnan, Shanxi, Fujian, Hunan and Anhui; and 4) strengthen the research infrastructure at the China CDC to support long-term research and training goals. There was a high degree of interaction between the China ICOHRTA and ongoing research projects in China such as the CIPRA, POL, HPTN, and CDC Gap programs. The overall goal of the China ICOHRTA was to establish an independent HIV/AIDS training center at the China CDC which can assist other academic and research institutions in China in the training of health professionals and researchers to combat the HIV/AIDS epidemic. UCLA and Yale took a major role in the academic aspects of the program initially but the major responsibility then shifted to the China CDC as the program matured and as graduates of the China ICOHRTA assumed leadership roles there and in its affiliated institutions. Successful implementation of the China ICOHRTA should significantly increase China's capacity to meet the challenge of the HIV/AIDS epidemic.

This new Fogarty International Center International Clinical Operational, Research and training award (ICOHRTA AIDS/TB (IAPH2) was awarded in 2009. This training program in China is being carried out with the China CDC and UCLA and supported at Yale through a subcontract with the China CDC (which is further strengthening research training capacity in the China CDC by developing and conducting implementation science training and enhancing core research support capabilities.
Since 2003 China has made significant progress in the scale-up and expansion of its national programs for HIV and TB. In the process, however, China now faces increasingly complex implementation barriers in the areas of program management and accountability, integration of prevention and treatment strategies, and coordination among existing programs. All of these challenges demand a core group of experts trained in implementation science who can oversee the transition from clinical research trials to national-level programs as part of a comprehensive HIV and TB control strategy.

In order to address these new challenges the China CDC, with the institutional support from the University of California, Los Angeles (UCLA) and Yale University. The goals of this program are to further strengthen research training capacity in CCDC by developing and conducting implementation science training and to enhance core research support capabilities so as to establish CCDC as a regional leader in research and training for HIV and TB prevention, care and treatment in Asia and the Pacific Region.

The CCDC is in a unique position to oversee this training program because of its multiple roles in China’s HIV and TB control strategies. As an academic institution that trains science and health professionals, a center for advanced scientific research, and an advising and implementing agency for national pubic health policy, it can effectively combine academic training with scientific research and implementation learning to provide a comprehensive learning environment for implementation science. These goals will be realized through the following three objectives to: 1) develop an implementation sciences training course which emphasizes effective translation of scientific research and proven interventions into large-scale, national level prevention and treatment programs for HIV/AIDS and TB; 2) train a cadre of implementation science experts through the China IAPH2 program which will use the newly designed implementation science course and a combination of course work, field experience, and directed research projects; and 3) further enhance core research support capabilities needed to apply for and manage research grants at China CDC.

AIDS's Adversary

Zunyou Wu is at the helm of China's battle against a virus that, if mismanaged poses an "unimaginable" epidemic
Article appearing on pages 22-23 of the fall 2009 edition of Yale Public Health magazine.

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